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PHILADELPHIA (July 7, 2000) -- In February, Dr. Paul F. Engstrom, a physician at Fox Chase Cancer Center, was among those who signed the Charter of Paris Against Cancer during an international summit for cancer specialists in Paris, France. The Charter calls for a bold commitment to scientific, social and political innovations that will enable the best possible delivery of cancer care worldwide. In the spirit of the Charter, Engstrom and Fox Chase surgeon Dr. John A. Ridge traveled half a world away to visit a cancer center in a Russian town where cancer care is not taken for granted.

Engstrom and Ridge led a delegation of Pennsylvania and New Jersey doctors and nurses and American Cancer Society representatives to Irkutsk at the invitation of Dr. Victoria Dvornichenko, director of the Irkutsk Regional Oncology Center.

The six-day trip began April 29. After a night in Moscow, the delegation traveled across five time zones to Irkutsk, the capital of Western Siberia. It was spring in Irkutsk, but snowflakes fell every day of their trip.

Located on the Angara River at the midpoint of the Trans Siberian Railway, Irkutsk is a city of 750,000. It is a center for gold prospecting, coal mining, fur trade and hydroelectric power about 50 miles from the world's deepest lake, Lake Baikal. The delegation first visited the Irkutsk Oncology Center on May 2, where they were greeted by Dvornichenko. The cancer center was built in the mid-'60s and opened in 1967.

"The surroundings reminded me of a U.S. facility in the 1920s because of the narrow halls, very thick walls and small rooms," Engstrom said. "The operating room facilities are comparable to those in the 1950s in the United States."

The hospital was originally built to house 100 patients. It now provides services for 367 inpatients and is overcrowded with patients and relatives waiting in the hallways.

"The small rooms are intended for two people, but in most of the rooms we found several patients in tiny beds placed end-to-end," Engstrom added.

The cancer center delivers all of its care on an inpatient basis. Outpatient care is not an option because there are too few nurses to make home visits. Furnishings are sparse and family members must provide bedding for the hospital stay. The family is also relied upon to supplement the meals for the patient. The average hospital stay is two to three weeks.

"The doctors and nurses worked incredibly hard just to provide basic medical care for the patients," Ridge explained. "The dedication of these doctors is amazing. The surgeons are twice as busy as we are, working without our modern technology and with enthusiasm, not despair.

"The nurses are also devoted and overworked. They have the option of working only two shifts; either an eight-hour shift or a 16-hour shift. At night, there is only one nurse for every 40 patients," said Ridge.

The hospital is staffed almost entirely by graduates of Irkutsk Medical School, who train locally in the medical center and the cancer center.

"While the facilities would not be acceptable by U.S. standards, the level of care was competent and provided by very knowledgeable oncologists," Engstrom said. "They know the conditions are not ideal, but quite simply, the government hasn't funded cancer care in this region or in many other areas of Russia."

The hospital has planned since 1986 to build a new 450-bed facility with 10 operating rooms and a boarding house for visiting patients. Support from the regional administration will be important for Dvornichenko to realize her dream of an up-to-date, modern oncology center serving all of Siberia.

"It was obvious that our visit was intended to have an impact on the leaders in the region," said Ridge. "We met with several governmental officials and expressed our concerns regarding the great need for a more modern cancer center."

Each daily trip to the cancer center brought the realization of how far advanced the Western world is in its standard of care. According to the Irkutsk doctors, about 7,000 new cancer cases are reported each year in their state.

Russia has no prostate cancer screening. Mammograms are offered, but only three mammography units serve three and a half million people.

If a woman has breast cancer, she has few options. Mastectomy is the only acceptable treatment. Similarly, a man with prostate cancer is treated by removing his testicles to reduce the level of hormones and control the disease.

"There appears to be equality in this noble profession in Irkutsk. Almost all of the hospital's section chiefs were women and about half of the other physicians were women," Engstrom remarked.

Engstrom, Ridge and the delegation returned to Philadelphia on May 7. They hope the foundation they laid will be the start of a lasting professional relationship that can help bring improved care to a region so desperately in need. "The Irkutsk Oncology Center staff and the people of Siberia would benefit tremendously from closer interaction with a U.S. comprehensive cancer center such as Fox Chase," Ridge said.

As a result of the visit, the American-Russian Cancer Education and Research Cooperative was formed and has set definite goals. The American Cancer Society's Eastern Division plans to provide support and training for a Russian chief executive officer who could establish the first voluntary cancer organization, the Irkutsk Cancer Society.

"One of the first things we want to do is write a grant to secure financial support for educational materials, journals, and joint U.S.-Russian oncology meetings," Engstrom announced.

The delegation discussed other possible actions, such as providing the doctors with cancer treatment guidelines developed by U.S. comprehensive cancer centers. The doctors and nurses are also hoping to help guide their Russian counterparts in the development of patient-care plans for more efficient use of the facility and a decrease in the length of the hospital stay. Technology currently exists that will allow the American doctors to assist the Russian physicians in the review of cancer cases via the Internet.

Finally, an invitation has been extended to selected physicians and nurses from Irkutsk to visit Fox Chase Cancer Center for a four-week educational period and to continue collaboration.

"I signed a Charter declaring my international concern about cancer," said Engstrom. "Those of us who signed it made a global commitment to the worldwide prevention and treatment of cancer. Fox Chase Cancer Center has long supported this philosophy. This relationship with our Russian colleagues is one way we can demonstrate that commitment."

Fox Chase Cancer Center, one of the nation's first comprehensive cancer centers designated by the National Cancer Institute in 1974, conducts basic and clinical research; programs of prevention, detection and treatment of cancer; and community outreach. For more information about Fox Chase activities, visit the Center's web site at: www.fccc.edu.

Fox Chase Cancer Center, part of the Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence four consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. For more information, call 1-888-FOX CHASE or (1-888-369-2427).

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